A History of Bracing for Idiopathic Scoliosis in North America

Abstract

The care of the patient with scoliosis has a history extending back over two millennia with cast and brace treatment being a relatively recent endeavor, the modern era comprising just over half a century. Much of the previous literature provides a modest overview with emphasis on the history of the operative management. To better understand the current concepts of brace treatment of scoliosis, an appreciation of the history of bracing would be helpful. As such, we review the history of the treatment of scoliosis with an emphasis on modern brace treatment, primarily from a North American perspective. Our review utilizes consideration of historical texts as well as current treatises on the history of scoliosis and includes discussion of brace development with their proponents' rationale for why they work along with an appraisal of their clinical outcomes. We provide an overview of the current standards of care and the braces typically employed toward that standard including: the Milwaukee brace, the Wilmington brace, the Boston brace, the Charleston brace, the Providence brace and the SpineCor brace. Finally, we discuss future trends including improvements in methods of determining the critical period of peak growth velocity in children with scoliosis, the exciting promise of gene markers for progressive scoliosis and ''internal bracing'' options.

Biomechanical Assessment of Providence Nighttime Brace for the Treatment of Adolescent Idiopathic Scoliosis

“…The measured and simulated in-brace skin pressure distribution followed the expected lateral three-point pressure pattern, a two-dimensional principle that is also documented in the orthotic literature [36,[39][40][41]. Additional pressures on the back, coming from the gravity exerted on supine patient trunk and its interaction with the bed support, represent an additional correction mechanism that reduced the sagittal and coronal curvatures.…”

Effective nonoperative treatment in juvenile idiopathic scoliosis

“…The Boston brace is a thoraco lumbo sacral orthosis (TLSO) and is applied to patients with a double and a single C-shaped curve pattern. It has to be worn at least 18 h a day to achieve a good result [24]. The Charleston night brace is a so-called 'side-bending brace', which bends the trunk towards the convexity, thereby overcorrecting the curve.…”

Optimal management of idiopathic scoliosis in adolescence

“…The success of treatment (progression below 6°) is achieved in 48.1%–85.7% of patients 97,98. Boston, Gensingen, Lapadula, Lyonese, Progressive Action Short Brace, Sforzesco, Sibilla are other examples of rigid TLSOs 99–102…”

“…The Charleston brace is a plastic orthotic device developed by Reed and Hooper in 1978, which keeps the spine in overcorrection by application of direct, lateral, and rotational forces on the trunk to move the spine toward the midline or beyond the midline 99,108. The success rate using this treatment is reported in the range of 12%–66% 109,110.…”